Pediatrics Flashcards
CC: “Our little boy is sick and getting worse.”
HPI: BW is a 22-month-old child brought to the Peds ER by his parents at 11:30 pm on 12/14. BW’s dad is a medical resident at the nearby orthopedic hospital, so he’s knowledgeable about the course of his son’s illness. He states that his son has had difficulty with asthma and allergies since he was 11 months old. He sees a pediatric pulmonologist. About 3 days ago, he noticed that his son had developed a mild cough and a runny nose. They used a humidifier and continued his regular meds. He seemed to be getting a little better. This morning the cough was noticeably worse, but the parents became very worried when his temp increased to 102.8 degrees Fahrenheit, and he began to have SOB about an hour ago. They came to the ER immediately.
Allergies: NKDA
PMH: Asthma and environmental allergies. Child is UTD on all vaccines.
Meds: Pulmicort Respules 0.25 mg BID at 0700 and 1600 via nebulizer and Singulair 4 mg daily at 2000
PE General Appearance: Child is febrile accompanied by concerned parents. Coughing continuously. Low O2 sats and developing stridor.
Labs:
CBC and chemistry pending
Lumbar puncture: Few RBCs, no WBC, no organism observed
Plan: Admit to medical floor for further work up and treatment.
BW’s father thinks his child should have a lumbar puncture. What disease is he concerned about?
a. Laryngotracheobronchitis
b. Meningitis
c. Respiratory syncytial virus
d. Enuresis
e. Polio
b
CC: “Our little boy is sick and getting worse.”
HPI: BW is a 22-month-old child brought to the Peds ER by his parents at 11:30 pm on 12/14. BW’s dad is a medical resident at the nearby orthopedic hospital, so he’s knowledgeable about the course of his son’s illness. He states that his son has had difficulty with asthma and allergies since he was 11 months old. He sees a pediatric pulmonologist. About 3 days ago, he noticed that his son had developed a mild cough and a runny nose. They used a humidifier and continued his regular meds. He seemed to be getting a little better. This morning the cough was noticeably worse, but the parents became very worried when his temp increased to 102.8 degrees Fahrenheit, and he began to have SOB about an hour ago. They came to the ER immediately.
Allergies: NKDA
PMH: Asthma and environmental allergies. Child is UTD on all vaccines.
Meds: Pulmicort Respules 0.25 mg BID at 0700 and 1600 via nebulizer and Singulair 4 mg daily at 2000
PE General Appearance: Child is febrile accompanied by concerned parents. Coughing continuously. Low O2 sats and developing stridor.
Labs:
CBC and chemistry pending
Lumbar puncture: Few RBCs, no WBC, no organism observed
Plan: Admit to medical floor for further work up and treatment.
The ER physician explains to the parents that he thinks BW’s presentation is most consistent with RSV. How is RSV generally managed in healthy older children?
a. Palivizumab
b. Vancomycin + cefotaxime
c. Dexamethosone + racemic epinephrine
d. Desmopressin
e. Supportive care
e
Which of the following groups of meds are generally not used in pediatric patients?
a. Iron, tetracyclines, morphine, and codeine
b. Tetracyclines, promethazine, acetaminophen, and fluoroquinolones
c. Codeine, iron, fluoroquinolones, and promethazine
d. Tetracyclines, codeine, promethazine, and fluoroquinolones
e. Morphine, promethazine, fluoroquinolones, and tetracyclines
d
An 8 y/o boy with enuresis will receive desmopressin tablets. Which of the following side effects is most likely?
a. Headache
b. Seizures
c. Insomnia
d. Skin photosensitivity/photophobia
e. Irritability/mood swings
a
Headache, fatigue, and possibly hyponatremia can occur; headache has the highest incidence (2-5%). These side effects are for the PO tablets. The nasal spray can cause other side effects, including rhinitis and epistaxis.
SA is a 2 y/o male child. His parents brought him to Urgent Care because he has had a gradual loss for appetite for 4 days. They say that he doesn’t want to get out of bed and seems tired during the day. SA’s mom says that he started to cry when she washed his during his bath today. She thought maybe his head hurt. Upon PE, his salivary glands are very swollen and tender to touch. What childhood illness is most likely in this case?
a. Varicella
b. Measles
c. Mumps
d. Polio
e. Pertussis
c
Swollen, tender salivary glands (parotitis) is emblematic of mumps. Many patients have very mild or no symptoms.
MW is a 4 y/o girl who has had a swollen right knee for the past few weeks. She can’t fully extend her leg and limped into the medical office. She weighs 28.6 pounds. Labs reveal an ESR of 12 mm/hr and report the ANA as positive. She receives a diagnosis of juvenile rheumatoid arthritis and is started on methotrexate and ibuprofen 10 mg/kg Q8H. The pharmacy has an ibuprofen suspension of 100 mg/5 mL. How many milliliters of ibuprofen suspension should be given every 8 hours?
a. 3 mL
b. 4 mL
c. 5 mL
d. 6.5 mL
e. 14.3 mL
d
An Rx is written for cefuroxime PO suspension 30 mg/kg/day divided BID x 10 days for a 7 y/o pt (weight 42 lbs). How many milligrams should the pt receive for each dose?
a. 72
b. 143
c. 286
d. 573
e. 630
c
RT is a 13 month-old child with a viral-induced fever. She’s 18.4 lbs and 28.8 inches. Her parents report that she has been fussy and irritable and feels “hot.” She has a fever of 39.4 degrees Celsius. Which of the following dosing recommendations for acetaminophen is correct for this child?
a. 80 mg Q2-4H PRN fever
b. 80 mg Q8-12H PRN fever
c. 100 mg Q4-6H PRN fever
d. 140 mg Q6-8H PRN fever
e. 184 mg Q4-6H PRN fever
c
The correct dosing of acetaminophen for infants (except neonates) and children is 10-15 mg/kg PO Q4-6H PRN.
DW is a 7 y/o male pt who has been prescribed Pediacare Children’s Cough and Runny Nose liquid (acetaminophen 160 mg/chlorpheniramine maleate 1 mg/dextromethorphan 5 mg per 5 mL). Which of the following are correct counseling points to give to DW’s dad?
a. Administer this med with a household teaspoon
b. Diphenhydramine is an expectant and will help DW cough up mucous
c. Chlorpheniramine is an antihistamine that can make DW more sleepy than normal
d. Minimize the amount of Children’s Tylenol given to DW while taking this med
e. Preferentially treat DW’s fevers with aspirin instead of Children’s Tylenol
c, d
Aspirin has been associated with Reye’s syndrome and shouldn’t be used in patients < 16 y/o.
A mom has a “colicky” newborn. He’s crying after she feeds him, which lasts about an hour. The child has been seen by the pediatrician who told the mom that the baby is fine and to use an OTC anti-gas agent. Which of the following products should be chosen?
a. Advil infant drops
b. Mylicon infant drops
c. Acetaminophen infant drops
d. Gaviscon infant drops
e. Phillips infant drops
b
Simethicone (Mylicon) infant drops help break up gas bubbles so that the baby can pass them out, which relieves pain. They aren’t absorbed, work safely, and provide a mild benefit. They are delivered via a dose calibrated dropper. Simethicone is taken after meals, and if needed, at bedtime.
Desmopressin is available in which of the following formulations?
a. Injection
b. Suppository, rectal
c. Nasal spray
d. Topical paste
e. Oral tablet
a, c, e
DJ is a 2 y/o boy being treated for otitis media. He’s going to receive an Rx for amoxicillin 90 mg/kg/day. He weighs 26 pounds and is 35 inches tall. How many milligrams of amoxicillin should be administered every 12 hours? Round to the nearest TEN milligrams.
530
Which of the following is correct about chickenpox?
a. It’s caused by rubella and prevented with the Boostrix vaccine.
b. It’s caused by human papillomavirus and prevented with the DTaP vaccine.
c. It’s caused by varicella zoster virus and prevented with the Shingrix vaccine.
d. It’s caused by rotavirus and prevented with the Rotarix vaccine.
e. It’s caused by varicella zoster virus and prevented with the Varivax vaccine.
e
A mom comes to the pharmacy asking for advice on something OTC to treat her daughter’s fever. Her daughter is 13 months old and weighs 11 pounds. Her rectal temp this morning was 39.7 degrees Celsius. The most appropriate recommendation is:
a. Monitor the child for another 24 hours to see if the fever subsides before treating OTC meds.
b. Recommend ibuprofen 25-50 mg Q6-8H.
c. Recommend acetaminophen 50-75 mg Q4-6H.
d. Recommend a cool bath to lower the child’s temp.
e. Seek medical care for the child immediately.
e
0-28 days
neonate
1 month-12 months
infant
1-2 years
toddler
2-12 years
child
13-18 years
adolescent
Match the age with its correct temperature that warrants urgent care for a child:
- < 3 months
- 3-6 months
- > 6 months
a. 101F / 38.3C
b. 103F / 39.4C
c. 100.4F / 38C
- c
- a
- b
What are the 4 safe practice recommendations when dispensing liquid medications that carry high risk?
- Stock only one strength if a dangerous drug comes in a variety of strengths. Place the container in a high-risk bin with instructions attached to the container.
- The dose should be written in terms of total mg and in mg/kg per dose.
- The pharmacist should check that the dose is appropriate for the child’s weight. Ask the caregiver for the child’s weight if it’s not available.
- The container label should include the dose (mg) and the volume (mL). Dispense with a measuring device.
Why is vitamin K given to newborns after birth?
to prevent bleeding
Low APGAR scores in preterm infants are usually due to what?
immature lung and heart development
What drugs can help close a PDA in a newborn?
NSAIDs (IV indomethacin)
NSAIDs must be administered within ______ of birth to be effective for closing a PDA.
14 days
Persistent pulmonary hypertension of the newborn (PPHN) may be linked to in utero ____ exposure.
SSRI
What drugs can be used for PPHN?
prostacyclin analogues and PDE-5 inhibitors
What causes respiratory distress syndrome (RDS)?
deficiency of surfactant production
Most babies born at < __ weeks gestation will receive surfactant immediately after birth or within the 1st few days of life.
35
“surf” or “actant”
surfactant products
Intestinal gas can be mildly relieved with what?
simethicone drops
Symptoms of intestinal gas will generally dissipate when child is around __-__ _______ old.
6-8 months
What things can reduce congestion in a child?
- cool-mist humidifier near the bedside (especially in the winter)
- sitting with the child in the bathroom while a hot shower creates steam in the room
Loosens mucus to provide congestion relief
suction with saline drops or spray
T/F: The FDA recommends OTC cough and cold medications in children >/= 1 year old.
False; the FDA does not recommend OTC cough and cold medications in children < TWO years old
Recommended for the treatment of intermittent constipation
polyethylene glycol 3350 (Miralax)
What fruits can be helpful for constipation?
prunes or pears
